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Breast Surgery - Breast Anatomy Breast

Introduction
dominant trend is visible in all branches of surgery Minimal Access idea incisional surgery to achieve the desired results with the effects of surgical reduction and Articles to facilitate faster patient recoveries. Plastic Surgeons not dealt with this issue over a longer time than other treatments have disciplines. The intention was to get the cosmetic benefit for patients by reducing and masking the scars.

in breast augmentation, one of the methods for the Achievement Through remote access incision placement, as exemplified by endoscopic transaxillary mammaplasty extensions and enhancements transumbilical endoscopy (tube) mammaplasty procedures. With these procedures, incisions are hidden first in the axillary crease and umbilicus, respectively, so scarring as a result of very hard to recognize. For this reason, methods are preferred by many physicians and patients alike.

acts with fiberoptics and endoscopic remote manipulation, combined with the progress of technology, which resulted in consistently good results the hands of doctors trained. Reticulating endoscopes and high definition camcorder offers new possibilities for visualization. These advances continue to strengthen over the enthusiasm for these endoscopic methods.

History
Transaxillary endoscopic procedure mammaplasty extensions

Transaxillary approach to breast augmentation was described by Troques in 1972 and Hoehler 1973.1,2 in addition to the obvious benefits of the hidden incision approach to facilitate direct access to subpectoral aircraft. With this technique, the inframammary crease and changed the origin of the pectoralis muscle dissected blindly, which is much higher rate of implant malposition. Limited exposure of the blind technique does not allow a complete breakdown of prepectoral fasciitis, which causes the high-riding implants Trends Or double-bubble appearance of the inframammary crease.

appearance Endoscopic surgery in 1990 allowed the use of an endoscope to breast surgery. Emory group reported their experience with endoscopic breast augmentation incision through the underarms in 1993, using a specialized retractor and air-filled optical cavity.3 Ho reported glycine irrigation technique used to create a fluid-filled cavity of the optical, although now also specialist applications and optical retractor air-filled cavity.4 increased control resulting from the direct visualization of dissection prevents many previous failures, the blind approach Pacha. Howard demonstrated benefits of an endoscope with lateral approach reduces the incidence of implant malposition from 8.6% to 2% in the case of endoscopes was used.5

Endoscopic transaxillary mammaplasty expansion is now widely used technique and has stood the test of time. However, experience is essential, more simple cases should be considered during the initial experience. Axillary approach has limited application in secondary matters.

Transumbilical endoscopic mammaplasty Extensions (tuba)

Transumbilical approach came into force in 1991 by Johnson and Christ and described in detail in 1993.6 technique is unique because it does not employ Regional or local incision, but rather uses a remote incision in the navel. TUBA endured criticism, but significant beginning has gained popularity as has been shown to be safe and reliable. TUBA Although technically more difficult, an increasing number of plastic surgeons gain knowledge of the procedures. Criticism has been the lack of basic operational control part, especially with regard to bleeding and the plane of dissection. With improved instrumentation and overall improvement in endoscopic skills these allegations have been proven invalid. The original study reported a lower level of Johnson less bleeding complications than other methods.6

Presentation
Importance initial consultation can not be overestimated. Talk to the four possible access to the patient's incision. Periareolar Current, ripple inframammary, axillary, and umbilical cord in the notches nonbiased way and assess the patient's enthusiasm axillary incision umbilical Or. Discuss the potential complications of breast augmentation, endoscopic complications emphasizing the unique methods. Discuss implant malposition, hematoma, underarms and lymph nodes. Finally, discuss the need for additional incisions inframammary crease to treat some complications of both approaches. All potential complications of breast augmentation should be discussed, including loss of nipple sensation, bleeding, infection, capsule contracture, asymmetry, unsatisfactory results, the need for revisionary Operations, and so on.

Perform a physical examination. Describe the location of the proposed cut and return the items and size of the surgical cutting of the tag. Pay particular attention to the distance from the areola is not inframammary crease and the transverse diameter of the breast. Assess the diameter of the breast, and then select the size and the implant immediately correct fold. The need for inframammary fold reduction in common is 1-2 cm but more than 3 cm should alert the doctor to the presence of constricted lower pole parenchyma and the need for Change, which can be a more direct approach to others. The ideal patient distances 5-6 cm from the areola is not inframammary crease, therefore requires less dissection worse.


Indications Indications for endoscopy to the patient's desire for breast augmentation incision remote and lack a well-developed inframammary crease to hide the crease incision below the horizontal axis of Visual. Contraindications


Zwæýenie lower pole

narrowed lower pole of the small distances from the inframammary crease to the areola is much more difficult and may require a radial scoring breast parenchyma. There is potential for implant displacement below overdissection (decrease) from the inframammary crease and the superior displacement of the implant underdissection the inframammary crease. In experienced hands and umbilical transaxillary approach can be used for this type of anatomy. Tubular breast



need herniated areola correction and scoring narrowed lower pole parenchyma makes perfect periareolar incision access tubular breast deformities.

the loss of

endoscopic breast augmentation can be performed in pseudoptosis and the degree of a drooping eyelid, but the anatomy of the inframammary crease required to reduce the base of vertical descent breast. Ptosis is considered not ideal for the inexperienced surgeon is, and I overdissection concern underdissection the inframammary crease.

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Vascular Anatomy of Blood
breast skin depends on the subdermal plexus, which is in contact with the primary deeper vessels supplying the breast parenchyma. Blood supply comes from (1) cutting the internal thoracic artery, (2) lateral artery chest pain, (3) thoracodorsal artery (4), the intercostal artery perforator, (5) thoracoacromial artery. The rich blood supply allows for a variety of reduction techniques, to ensure the viability of skin flaps after surgery.

innervation Sensory innervation of the breast breast
dermatomal in nature. It is mainly derived from the anterior and anteromedial branches of thoracic intercostal nerves T3-T5. Nadobojczykowy nerves from the lower fiber innervation of the cervical plexus and the upper and lateral parts of the breast. Scientists think the feeling to the nipple from the lateral cutaneous branch of T4.

Breast parenchyma and support structures
Breasts are composed of both adipose tissue and milk for the production of glandular tissue. The ratio of body fat compared to glandular varies between people. In addition, the onset of menopause (ie, a decrease in estrogen levels), the ratio of body fat increases the glandular tissue decreases.

breast soft tissues are supported by the suspensory ligaments of Cooper. These ligaments run throughout the breast parenchyma tissue of the deep fascia of the chest and attached to the dermis of the skin. Because they are not strained, as they allow for natural motion of the breast. Ultimately, this leads to breast ptosis of these ligaments to relax with age and time.

similar to the breast muscles Breast
lies on the muscles, which encases the chest. The muscles involved include the pectoralis major, serratus anterior, external oblique and rectus abdominus fascia. Blood supply, which provides movement of those muscles until then pierces the flesh of the breast, and thus the blood supply to the breast. By maintaining continuity with the main muscle, breast tissue is richly perfused, thereby preventing the complications of plastic surgery and reconstructive surgery requiring the placement of breast implants.

pectoralis major muscle

pectoralis major is a broad muscle that extends from its origin at the medial clavicle and sternum lateral to its insertion on the humerus. Thoracoacromial is its main artery blood flow in the intercostal perforating arteries arising from the inner segment to provide breast's blood supply. Medial and lateral anterior thoracic nerves provide innervation to the muscle, entering posteriorly and his side. Activities pectoralis major is the flex, adduct, and rotate the arm medially.

pectoralis major is extremely important for both aesthetic and reconstructive breast surgery because it provides cover muscle breast implants. In surgery, the pectoralis major muscle covers the implant, providing a reduction in the risk of implant extrusion in the skin and subcutaneous tissue core are often considerably reduced after mastectomy. Provides additional muscle tissue between the implant and the skin, thus reducing the palpability of the implant. Often placing the implant under the muscle makes it noticeable when it is contracted pectoralis. In such cases, it may help release the breast muscle with its inferior and medial attachments to reduce the frequency of contractions noticeable. In addition, in a worse version of the pectoralis muscle implant lower position can be achieved by a more aesthetic appearance.

serratus anterior muscle

serratus anterior muscle is the large muscle that runs along the anterolateral chest wall. Its origin is the outer surface of the upper limit of the first through eighth ribs and the insertion is on the deep surface of the blade. Its vascular supply is also derived from the lateral thoracic artery and branches from the thoracodorsal artery. Long thoracic nerve innervate serratus anterior is used, which acts to rotate the shoulder, arm and raise the point of drawing the shoulder forward toward the body. Transection of long thoracic nerve is carefully avoided during the dissection of axillary lymph nodes, because its loss results, "winging" as the blade is released from the chest and moves up and out. Since

serratus anterior lateral aspect of the breast based on the aesthetic surgery, blunt elevation pectoralis major inadvertently puts aside a small part of the serratus muscle. In order to completely cover the implant with the muscle in surgery, often serratus anterior must be substantially increased to obtain a sufficient layer of muscle in order to ensure coverage. Rectus abdominus

rectus abdominus

muscle provides a lower limit of the breast. It is elongated muscle that runs from the beginning of the comb interpubic cartilage and ligaments to the insertion Teenager mieczykowaty and cartilage of the fifth through seventh ribs. It acts to compress the abdomen and flex the spine. 7. to 12 intercostal nerves provide sensation to the skin covering and energize muscles. Myocardial blood flow passes through the network between the superior and inferior deep epigastric artery.

placing an implant for breast reconstruction in an effort to achieve full protection of the muscles, the rectus fascia often must be raised to the implant site so much worse. This dense thick fascia is often closely adjacent to the rib below. When I raised and released, proper positioning and expansion of the implant can be continued.

external oblique muscle

external oblique is a broad muscle that runs along the anterolateral aspect of the abdomen and chest. Its origin is from the lower eight ribs, and its introduction is along the front half of the iliac crest and linea alba aponeurosis from the xiphoid to the pubis. It acts to compress the abdomen, flex and rotate to one side of the spine and lower ribs. 7. to 12 intercostal nerves innervate the external oblique to serve. Segmental blood supply is maintained by the inferior intercostal arteries 8 rear.

Mięsień skośny zewnętrzny abuts piersi gorszy aspekt bocznej. Podwyższone wraz z rectus powięzi abdominus świadczenia niższe pokrycia implantów piersi w chirurgii rekonstrukcyjnej, jego powięzi, jak powięzi rectus muscle abdominus, muszą być wydane odpowiednio w celu zapewnienia właściwego miejsca i rozbudowy implantu. W chirurgii estetycznej, umieszczenie implantu inferiorly zazwyczaj nie jest poniżej tych powięziowy załączników. Jeżeli implant jest umieszczony z tyłu deski rozdzielczej, implant często "Jazda zbyt wysokie" i może doprowadzić do "double bubble" efekt, w którym miąższ piersi ślizga się i wyłącza implant

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